Washington State Specific Strategies

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The Washington Health Insurance Partnership

In 2007, House Bill 1569 authorized the creation of a Massachusetts-style Connector called the Washington Health Insurance Partnership (HIP) under the direction of a seven member Board. HIP is initially targeting small employers with low-income workers. For a small employer to designate HIP as its health benefits administrator, the employer has to have at least one eligible employee (a Washington resident earning less than 200 percent FPL) and set up a cafeteria plan as defined by Section 125 of the federal income tax code. Cafeteria plans allow pre-tax premium payments by both an employer and an employee. If a small employer meets these two conditions, all of its employees regardless of income can purchase through HIP (even after leaving employment).
In addition, the legislation establishes sliding scale premium subsidies for individuals who earn less than 200 percent FPL based on gross family income on a similar schedule as that currently used by the Washington Basic Health Plan.
In 2008, House Bill 2537 made several technical changes as requested by the HIP board. Two provisions of the original bill, employee choice and portability, are delayed by a start up phase of up to two years. It also narrowed eligibility requirements for employers, who must now attest to the fact that: (a) the employer does not currently offer health insurance to its employees, and (b) at least 50 percent of the employer's employees are low-wage workers. HIP will now begin to accept enrollments January 1, 2009, with coverage to begin March 1, 2009 (2537 delayed implementation three months).
Basic Health - Created in 1988, Basic Health (BH) is a state-sponsored program that provides health care coverage to WashingtonState residents with family incomes below 200 percent FPL. Monthly premiums are based on family size, income, age, and health plan choice, with a sliding scale state subsidy. Member cost-sharing comes in the form of copays, coinsurance, and deductibles. A standardized benefits package is offered through private insurance carriers offering a “managed care plan.” To qualify, applicants must meet BH's income guidelines, live in Washington state, not be eligible for Medicare, not be a full-time student in the United States on a student visa, and not be institutionalized at the time of enrollment. As of Fall of 2006, the program covered approximately 100,000 subsidized enrollees. BH and Medicaid coordinate coverage to support family unity for low-income families. Close to 15,000 additional children receive coverage via BH and Medicaid covers approximately 22,000 children. Medicaid coverage is delivered through BH contracted health plans.
In addition, there are several small sub-programs included in BH and that are included in the total enrollment figure of approximately 100,000 subsidized BH enrollees. The “financial sponsors” program allows a third party to pay the BH premium. As of the Fall of 2006 about 28,000 BH enrollees had financial sponsors. Employers may also sponsor coverage for their employees who meet BH eligibility criteria. As of Fall of 2006, about 250 BH enrollees were enrolled in the employer-sponsored program. BH is also available to foster parents and homecare agency workers or individual providers employed by clients of the state’s Medicaid Aging and Disability program.

Coverage for Non-Citizen Children - In January 2006, the Washington State Children’s Health Program (CHP) was re-instated in Medicaid to provide health coverage for non-citizen children in families up to 100 percent of federal povertyFunding has been provided to cover about 14,000 CHP enrollees. In addition, non-citizen children in families up to 200 percent of federal poverty may enroll in Basic Health.